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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 29-31

Giant liposarcoma of the anterior chest wall


1 Department of Head and Neck Oncology, Acharya Harihar Regional Cancer Centre, Cuttack, Odisha, India
2 Department of Surgical Oncology, HCG Panda Cancer Hospital, Cuttack, Odisha, India
3 Department of Pathology, Acharya Harihar Regional Cancer Centre, Cuttack, Odisha, India

Date of Web Publication21-Jun-2018

Correspondence Address:
Dr. Sasmita Panda
Department of Pathology, Acharya Harihar Regional Cancer Centre, Cuttack - 753 004, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/oji.oji_10_18

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  Abstract 


Liposarcoma is a malignant tumor of the adipose tissue and is primarily a tumor of adults above the age group of 50 years. It may occur anywhere in the body. However, the most common sites are thigh and retroperitoneum. Liposarcoma with the chest wall primary is a rare entity with only few cases reported. We report a case of well-differentiated liposarcoma of the anterior chest wall in a 75-year-old male with a presentation of large growth extending to the anterior neck and successfully operated.

Keywords: Chest wall, excision, liposarcoma, well-differentiated


How to cite this article:
Panda S, Panda K, Panda S. Giant liposarcoma of the anterior chest wall. Oncol J India 2018;2:29-31

How to cite this URL:
Panda S, Panda K, Panda S. Giant liposarcoma of the anterior chest wall. Oncol J India [serial online] 2018 [cited 2018 Sep 18];2:29-31. Available from: http://www.ojionline.org/text.asp?2018/2/2/29/234899




  Introduction Top


Malignant fibrous histiocytoma is the most common soft-tissue sarcoma in adults followed by liposarcoma.[1] The origin of liposarcoma is from the primitive mesenchymal cells deep in the soft tissue, such as the intermuscular and fascial planes.[1] Thigh and retroperitoneum are the most common sites for liposarcomas.[2] Head and neck, chest wall, and mediastinum are the rare sites of occurrence.[3] Here, we report an anterior chest wall liposarcoma in a 75-year-old male extending to the anterior neck.


  Case Report Top


A 75-year-old male presented with a large swelling of anterior chest wall extending to anterior neck. The swelling started at anterior chest wall since 4 years back and gradually increased in size to the present size [Figure 1]a. On local examination, a large pendulous swelling of size approximately 12 cm × 18 cm with nodular appearance was found over the anterior chest wall extending to the anterior neck covering the entire thyroid region and the lesion was more prominent in the mid portion of the anterior chest wall. As the lesion was not causing any significant symptom at the initial phase, the patient not came to the hospital for the same. The lesion gradually increased in size causing problems in day-to-day activities, and the patient went to the hospital for the same. His routine hematological examinations were within the normal limit. Magnetic resonance imaging of the chest and neck showed a huge lobulated mass of size approximately 26 cm × 24 cm × 8 cm involving anterior chest wall and neck showing high-signal intensity on T1-weighted image with thickened septa. On T1-weighted contrast images, the septa showed enhancement. Contrast-enhanced computed tomography (CECT) scan of the chest and neck showed a large soft-tissue mass at the anterior chest wall in front of the ribs with predominantly fat attenuation and heterogeneous enhancement of thickened septa within the lesion. There is a discrete large lobulated fatty component at the superior aspect of the mass extending to the neck indenting right lobe of thyroid without compression of trachea and definite invasion of neck structures [Figure 1]b and [Figure 1]c. There was the absence of any obvious intrathoracic extension [Figure 1]d, vessels in the neck not involved and no evidence of lung metastasis. Biopsy from the lesion at the chest wall showed features of liposarcoma. Fine-needle aspiration cytology from the neck lesion revealed features of lipomatous tumor. There was the absence of any distant metastasis after a thorough investigation. CECT scan of the chest and ultrasound of the abdomen ruled out the presence of any lung metastasis and liver metastasis, respectively.
Figure 1: Showing clinical photo of liposarcoma (a), and contrast-enhanced computed tomography scan of neck and chest showing a lobulated soft-tissue lesion in the anterior chest wall extending to neck with a predominantly fatty component; the lesion showing without any tracheal compression on coronal image (b), up to infrahyoid extension on sagittal image (c), and without any obvious intrathoracic extension on axial image (d)

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The patient was planned for possible radical excision of the tumor after discussion in the tumor board. After the preoperative assessment, radical excision had performed. The whole mass including neck extension removed in toto by a long midline and one curved incision on the right side starting from the lower end [Figure 2]a and [Figure 2]b. Operated specimen revealed the mass with weight of 3 kg [Figure 2]c. The postoperative status was uneventful with healthy scar [Figure 2]d, and the patient recovered well. The gross specimen sent for microscopic examination revealed features of low-grade liposarcoma with the entire cut-margins negative [Figure 3]a and [Figure 3]b.
Figure 2: (a) Intraoperative tumor location, (b) intraoperative chest after excision of tumor, (c) postoperative specimen showing multilobulated reddish yellow soft mass, and (d) postoperative scar

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Figure 3: Microscopic examination of the operated specimen showing (a) presence of fatty tissue, collagen bundle, atypical stromal cells, and occasional lipoblast on (H and E, ×100) and (b) presence of lipoblasts and atypical stromal cells on (H and E, ×100) confirming sclerosing variant of well-differentiated liposarcoma

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Although the lesions larger than 5 cm should be considered for adjuvant radiation therapy as a proven method of limiting local recurrence, the present case did not receive any adjuvant therapy considering low grade, 75 years of age group, and larger area of the radiation field. After a follow-up of 6½ months, the patient was doing well without any recurrence or distant metastasis.


  Discussions Top


Liposarcoma has three principal forms: well differentiated, myxoid or round cell, and pleomorphic. Each of these types has distinct morphology, natural histology, and karyotypic and genetic aberrations. Well-differentiated variant is the most common constituting 40%–45% of all aggressive adipocytic tumors, commonly present in the fifth–seventh decades of life, and majority cases occur in the deep soft tissue of the extremities.[4] The common sites of occurrence with decreasing order of frequency are thigh, retroperitoneum, paratesticular area, and mediastinum. It usually a locally aggressive, nonmetastasizing malignant mesenchymal neoplasm composed of a mature adipocytic proliferation. It usually presents as a painless, slow-growing deep-seated mass and can present to a size up to 20 cm in diameter, especially when the retroperitoneum primary.[4]

Soft-tissue sarcoma with chest wall primary is a rare entity. Liposarcoma is the second-most common primary soft-tissue sarcoma of the chest wall.[3] Few cases of liposarcoma with the chest wall primary have been reported in the literature.[5] Most of the primary chest wall liposarcomas are low-grade well differentiated as in the present case, and the pleomorphic subtype is extremely rare.[6] Most of the liposarcomas develop in the intermuscular fascia, for which commonly present on or under the muscle.

The appearance of liposarcomas on CT scan varies from a predominantly fat-containing lesion to a solid mass and heterogeneity depends on the necrosis, calcification, vascularity, cystic change, and soft-tissue component. However, it is very difficult to differentiate liposarcoma from a lipoma on the preoperative radiological assessment and needs histopathological study with subtyping.[7] Complete surgical excision with clear margins is the preferred treatment for most of the chest wall liposarcomas due to low-grade histological differentiation.[8] High-grade liposarcomas should be treated with adjuvant treatment. Survival of the chest wall liposarcoma is similar to the other extremities liposarcoma. Survival depends on the histological differentiation, location and size of the tumors, and the completeness and accuracy of the surgery.[3] The anatomical location of the tumor is the most important prognostic factor for well-differentiated liposarcomas.[4] The follow-up schedule for the low-grade localized disease after radical surgery is not specific. The follow-up at more relaxed intervals is every 4–6 months in the first 3–5 years and then yearly thereafter.[1]

The present case is a well-differentiated variant without any distant metastasis. Radical excision has been possible with healthy margins. No chemotherapy or radiotherapy has been advised considering the doubtful benefits of such adjuvant treatment and advanced age.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lee EJ, Jeong TJ, Cho HR, Lew BL, Sim WY. A liposarcoma of the chest wall and back. J Am Acad Dermatol 2011;64:1202-3.  Back to cited text no. 1
[PUBMED]    
2.
Coindre JM, Pedeutour F. Pleomorphic liposarcoma. In: Fletcher CD, Bridge JA, Hogendoorn PC, Mertens F, editors. WHO Classification of Tumours of Soft Tissue and Bone. 4th ed. Lyon, France: International Agency for Research on Cancer Press; 2013. p. 42-3.  Back to cited text no. 2
    
3.
Ghosh P, Saha K. A rare case of primary anterior chest wall pleomorphic liposarcoma. Saudi J Health Sci 2014;3:121-3.  Back to cited text no. 3
  [Full text]  
4.
Salemis NS. Intramuscular atypical lipomatous tumor/well-differentiated liposarcoma of the pectoralis major masquerading as a breast tumor: Management and review of the literature. Int Surg 2015;100:194-8.  Back to cited text no. 4
[PUBMED]    
5.
Fernández EL, Plasencia LD, Palma JP, Pallares AC. Giant ulcerated pleomorphic liposarcoma of the chest wall. J Thorac Oncol 2007;2:1126-7.  Back to cited text no. 5
    
6.
Shoji T, Sonobe M, Okubo K, Wada H, Bando T, Date H, et al. Giant primary liposarcoma of the chest. Gen Thorac Cardiovasc Surg 2009;57:159-61.  Back to cited text no. 6
    
7.
Bicakcioglu P, Sak SD, Tastepe AI. Liposarcoma of the chest wall. Transformation of dedifferentiated liposarcoma from a recurrent lipoma. Saudi Med J 2012;33:901-3.  Back to cited text no. 7
[PUBMED]    
8.
Dei Tos AP. Adipocytic tumors. In: Fople AL, Inwards CY, editors. Bone and Soft Tissue Pathology. Philadelphia, PA: Churchill Livingstone; 2010. p. 97-118.  Back to cited text no. 8
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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